These are 14 fertility myths most people believe, but that science has debunked:

MYTH #1. Maternity wise, 40s is the new 30s

Our life expectancy is longer, and we tend to postpone maternity due to career or study purposes. From that aspect, the 40s can be easily regarded as the new 30s. Unfortunately, this is not true for our ovaries: by the age of 30, a healthy woman has about a 20% chance of conceiving each month, by the time she reaches 40 her odds drop to about 5%.

This is one of the most commonly believed misconceptions: unaware of the age-related fertility decline, many women start seeking help to conceive in their 40s, when they may have already missed the opportunity to become parents.

You should be aware that there is a biological clock, and it’s ticking! If for personal reasons you cannot have a child right now, you may freeze your eggs to use them in the future.

You will find plenty of (mis)information on this topic! In general, it is said that the best positions for getting pregnant are the missionary position (the woman lying on her back, her partner on top) and the “doggy position” (rear vaginal penetration, with the woman on her hands and knees) because they provide the deepest penetration, allowing the man to ejaculate closer to the opening of the cervix.

In fact, there’s no scientific evidence to prove that. This belief is largely based on a single study that looked at the position of the penis in relation to these two sex positions, but it didn’t address pregnancy chances at all.

MYTH #3. Lifting your legs in the air for 20 minutes after having sex will help you get pregnant

You have probably heard this one: “lie in bed with your feet in the air after having sex to increase your chances of getting pregnant”. In fact, this is not (totally) true. You may lay in bed for 10-15 minutes after intercourse, as by this time the sperm have largely reached the cervix, and many may even be inside the tube.

In fact, a new study challenged both beliefs: women having artificial insemination were split into two groups – one that rested on their back with their knees raised for 15 minutes after the procedure and one that got up immediately. It turned out that, after several courses of treatment, 32% of the immobile group fell pregnant, compared with 40% per cent in the active group.

Therefore, there is no need to put pillows under your bottom during intercourse to get an advantageous tilt, or to perform cycling motions with your feet in the air.

MYTH #4. If we have sex every day the sperm becomes too weak, reducing our chances of getting pregnant

How often should we make love to boost our chances of pregnancy? You will find all sorts of advice on the web: every other day, 3 times a week, every single day! Which one is correct?

One thing is clear: abstinence intervals greater than 5 days impair the sperm number and quality. Nevertheless, there is not much difference whether men ejaculate every day or every other day. Most fertility specialists used to recommend intercourse every other day, as this would increase sperm quality, particularly in men with lower sperm counts (oligozoospermia). However, recent studies show exactly the opposite: oligozoospermic men had better semen quality with daily ejaculation!

Recent scientific evidence suggests that making love every day confers a slight advantage: the highest chances of pregnancy (37% per cycle) were associated with daily intercourse, although sex on alternate days had comparable pregnancy rates (33%). On the other hand, we should keep in mind that the “obligation” to have sex every day may induce unnecessary stress to the couple, resulting in lack of sexual desire, low self esteem, and ultimately reduced frequency of intercourse.

Therefore, reproductive efficiency is highest when you have sex every day or every other day. The optimal frequency, though, is best defined by each couple’s own preference.

MYTH # 5. We only have sex when I ovulate, on day 14 of my cycle

Ovulation (when the egg drops from the ovary into the tubes) occurs once a month, usually between day 11 and day 21 of the cycle (measured from the first day of your period).

Each woman ovulates on her own schedule. While it is usually said that a woman with a 28-day cycle ovulates on cycle day 14, that’s not necessarily true: a study found that fewer than 10 percent of women with regular, 28-day cycles were ovulating on day 14.

To boost your odds to become pregnant, have sex before and during ovulation, every day or every other day. If your cycles are irregular and you cannot figure out your fertile days, you may use an ovulation predictor kit, or otherwise visit a specialist, who can help you find your fertile window.

MYTH # 6. Smoking doesn’t affect our chances of getting pregnant. I will quit smoking as soon as I get pregnant

You are most likely aware that smoking during pregnancy is dangerous, as it can lead to miscarriage, premature birth, low-birthweight babies and -according to recent studies– congenital malformations.

But you should also know that smoking is harmful for your fertility: smoking as few as five cigarettes per day is associated with reduced fertility, both in women and men, and this seems to be true even for secondhand smoking. It has been estimated that smokers may have a 10-40% lower monthly fecundity (fertility) rate, and that up to 13% of infertility is due to smoking.

Smoking can affect ovulation, as well as the ability of the fertilized egg to implant in the uterus. The effect of tobacco is so harmful for the ovaries that menopause occurs, on average, one to four years earlier in smoking women than in nonsmoking ones.

Men are also affected by tobacco: decreases in sperm density, motility, and abnormalities in sperm morphology have been observed in men who smoke, which impact a man’s ability to fertilize an egg.

Therefore, before trying for a baby, do yourself a favor … and put out the cigarette for good!

MYTH # 7. You don’t need to worry about your age. There’s always IVF

Another common misconception! Many women believe that, if age-related infertility strikes, they can overcome their problem by getting treated with in vitro fertilization (IVF). In fact, just as natural fertility declines with age, success rates with IVF also decline as a woman gets older.

According to the USA Center for Disease Control and Prevention (CDC), women younger than 35 years old have 33% chances of having a baby after IVF; for women ages 38 to 40 the success rate drops to 17%, whilethose 43 to 44 years old have only 3% chances of giving birth after IVF (using their own eggs).

IVF is not a guarantee to have a baby, and does not extend a woman’s reproductive life. Despite the number of celebrities having babies in their mid-40s and beyond, they may have not necessarily used their own eggs. While every woman has the right to keep her privacy, there is a wrong perception left that fertility treatments can extend a woman’s fertility span. There is a very low probability of improving success of conceiving after age 43 by using assisted reproduction using your own eggs. Nevertheless, you may opt to use oocyte donation (eggs of a younger woman) if age-related infertility stands in the way of parenthood.

MYTH # 8. A woman can’t get pregnant if she doesn’t have an orgasm

For men, things are clear: no orgasm, no pregnancy, as ejaculation occurs during orgasm. Well, that’s not entirely true: semen can be released during intercourse prior to orgasm in the so-called pre-ejaculation fluid, or pre-come (read more here).

For women though, getting pregnant has nothing to do with an orgasm. But could female orgasm improve the chances for conception? The answer is not clear.

Researchers have wondered for years about the purpose of female orgasm, and many theories have been proposed:

Just the pleasure it provokes, so that women want to reproduce and preserve the species!

The “poleaxe” hypothesis: orgasms make women feel relaxed and sleepy so that they will lie down after sex and the sperm reach their destination more easily.

The “upsuck” theory: the contractions of the uterus “suck up” the sperm released in the vagina and help them travel through the uterus to the tubes.

Pair bonding: the hormones produced during orgasm (such as oxytocin and prolactin) contribute to warm feelings towards her partner.

Orgasms are not necessary to get pregnant, but there are plenty of good reasons to have one! Nevertheless, it is not uncommon that women trying to conceive link the desire for an orgasm with their desire to have a baby; this leads to psychological pressure and difficulty achieving orgasm, adding frustration to a process that is supposed to be pleasurable…

Try not to consider the orgasm just as goal to get pregnant. Enjoy the intimate time with your partner, without any pressure. If you have an orgasm, great. If not, that’s fine, too!

MYTH #9. We’ve already had one child, so conceiving again will be easy

Perhaps, but it’s no guarantee. Many individuals experience secondary infertility, or difficulty conceiving a second or subsequent child.

Secondary infertility may be caused by age-related factors, both for you and your partner. Sometimes, a new underlying medical condition develops. Eventually, a fertility issue that always existed gets worse; while it didn’t prevent pregnancy before, now it has become a problem. A previous pregnancy may actually be the reason you don’t get pregnant again: surgical complications or infection after childbirth may have provoked scarring, which may in turn led to infertility.

Things change with time. Even if you got easily pregnant on your own before, if you’re struggling to have another child talk to your doctor, who can advice you on the next steps to follow.

MYTH #10. Infertility is a woman’s issue

Typically, the causes of infertility break down like this:

Approximately one third of the couples struggle with male infertility;

In another third, the problem is female infertility;

The remaining third will either face both male and female fertility issues, or a cause will never be found (unexplained infertility).

Common causes of female infertily are: age, PCOS (polycystic ovary syndrome), tubal or pelvic issues, endometriosis, and family history.

Common causes of male infertility tend to be from prior surgery, infection, or a problem present at birth.

As part of the preliminary work-up to determine the cause and treatmentof infertility, both women and men will need to undergo clinical and specialized complementary exams.

MYTH #11. Men’s age doesn’t matter

While some men can father children into their 50’s or 60’s, men’s fertility isn’t age-proof: it starts declining in their 40s, although less drastically as compared to women’s fertility.

As a man ages, the concentration of mobile, healthy sperm and semen volume overall will decrease. It is clear now that men over the age of 40 have higher chances of having children with chromosomal abnormalities, causing miscarriages in their female partners. Moreover, researchers have found a direct link between paternal age and an increased risk of autism and schizophrenia.

A man’s age does matter. While men may not have a complete drop off in fertility like women do, “advanced paternal age” is something couples should be aware of. Men’s biological clock is also ticking!

MYTH #12. If I take good care of my general health, my fertility will be in check too

Whereas a healthy body and mind may boost fertility in certain cases, most infertility situations cannot be resolved by a lifestyle or diet change, particularly those related to age.

It is a common belief that certain diet types can help you get pregnant. There is no evidence that vegetarian diets, low-fat diets, antioxidant- or vitamin-enriched diets will increase your chances of having a child.

A woman’s weight plays a role in fertility: those who are either very thin or obese may find it hard to conceive. If you are trying to get pregnant, learn more about some lifestyle tips to boost your chances of getting pregnant here.

MYTH #13. If a man can ejaculate, his fertility is fine

Many myths surround male fertility and their sexual performance. It is a common (and unfortunate) myth that if a man’s fertility is compromised, this means his sexual performance is the problem. This is not true. Problems with sperm count, shape, and movement are the primary causes of male infertility.

Another common myth is that you can tell there is a problem with the sperm just by looking at the semen. In fact, even men that have no sperm cells at all (azoospermia) usually have normal-looking semen.

For the vast majority of men with infertility, there are no visible or obvious signs that anything is wrong. Healthy erectile function and normal ejaculation are not guarantee that the sperm is in good shape.

That said, erectile dysfunction can be a possible symptom of infertility; it may due to low testosterone levels or a physical injury. Difficulty with ejaculation can also be a signal certain medical problems. But these are uncommon signs of male infertility.

If you are struggling to get pregnant, have your partner check in with his doctor. A semen analysis will help clarify whether his sperm are fit for conception.

MYTH #14. The birth control pill will affect your future fertility

All scientific evidence agrees that hormonal contraceptives do not make women sterile. Moreover, they may confer increased likelihood of pregnancy with long-term use, and in certain cases they can also preservefertility. Read more on the contraceptive pill here.

To summarize:

Myths and misconceptions regarding fertility and conception are, unfortunately,widely disseminated. This is a serious problem, as misinformation may lead not only to unnecessary stress, but also to take wrong decisions…

Get yourself well informed! Consult your gynecologist, who can help you with any concerns you have. Your doctor can also give you some tips on lifestyle changes to optimize your fertility, prescribe some exams, and tell you when to come back if you don’t achieve pregnancy on your own.

Last, a good piece of advice: if you want to get pregnant, have lots of sex – as much as you want, whenever you want – and enjoy it! After you have had sex, do whatever you want – just don’t smoke 😉

In the Part 1of Home birth: Smart choice or risky business? we analyzed the issues of personal satisfaction, maternal safety and baby’s risks. Part 2 dealt with hospital transfers, water birth and the situation in the Netherlands. Check out the last three reasons women choose home birth, and read the final conclusion to decide whether home birth is a clever or a dangerous option…

7) “Home birth is cheap”

Home birth is cheaper… provided that no transfer is needed and nothing goes wrong

Cost-effectiveness is an important issue in every country with an organized health system. Countries like England or the Netherlands, where the National Health System (NHS) covers the cost of deliveries, have calculated that is cheaper that women deliver at home, avoiding a more expensive hospital admission. For example, the UK NHS “prices” home birth £1066 and birth at a hospital £1631. The economical factor is one of the reasons certain professional organizations support home labor, such as the Royal College of Obstetrics and Gynaecologists (RCOG) which states that: “home birth is the most cost-effective place for delivery”.

But this cost analysis has been challenged, as it does not take in consideration the high transport rates; in fact, a Dutch report calculates a general 3-fold increase of costs in patients transported during labor, when the costs of the midwife, the transport system, the obstetrician and the hospital are included. In addition, the costs derived from the maintenance of an adequate transport system (ambulances and trained staff) should not be neglected. Assuming increased neonatal risks, admissions to the neonatal intensive care unit, the lifetime costs of supporting neurologically disabled children and potentially increased professional liability costs resulting from a complicated home birth can potentially inflate the costs.

Indicative of these unexpected expenses is the article Home birth: What the hell was I thinking? A journalist from The Guardian went on a mission following a home birth. After managing to deliver her child at home, both the woman and her baby had a complication and needed to be transferred to a hospital. Since the baby and the mother were not allowed to be in the same ambulance, two ambulances were required…

Regarding the costs arising from a private home birth, the situation varies in different countries; in the USA home births are not covered by health insurances, and a couple is expected to pay $1500 to 4500 to the midwife. Hospital births can range from $3,296 to 37,227, although they are usually covered totally or partially by the insurance. Of note: adoctor gets paid about $2500-4000, same as a midwife. Ιn Europe, a couple is expected to pay about 2000-3000 €; recently the Italian newspaper La Stampa published the article Home birth: a 3000 € luxury that does not convince doctors.

Indeed, Mother nature is great. If you think about it, the whole process of labor and delivery seems to be so perfect, almost magical… But “natural” is not a synonym of “risk-free”. Sometimes Mother nature can play strange games. We may believe we have everything under control, but things may flip just in a second: think earthquakes, or tsunamis… Exactly the same thing applies to childbirth: even when someone seems to be “low risk”, disaster can strike without any warning …

“Childbirth is inherently dangerous,” writes in her blogAmy Tuteur, an American obstetrician gynecologist. “In every time, place and culture, it is one of the leading causes of death of young women. And the day of birth is the most dangerous day in the entire 18 years of childhood”. Finally, she adds: “Why does childbirth seem so safe? Because of modern obstetrics. Modern obstetrics has lowered the neonatal mortality rate 90 per cent and the maternal mortality rate 99 per cent over the past 100 years.”

The absolute confidence in a woman body’s ability to deliver is expressed bysupporters of unassisted childbirth (UC), the “hard core” version of home birth, which, although practised already since the 70s, it has lately seen a resurgence. Also known as freebirth, DIY (do-it-yourself) birth, unhindered birth, or unassisted home birth, it refers to women that intentionally deliver without the assistance of a physician or midwife; they may be completely alone (“solo birth”) or assisted by a lay person, such as the spouse, family, friend, or a non-professional birth attendant. There are no data on safety of UC, except that coming from a religious group in Indiana (USA) that found a perinatal mortality rate 2,7 times higher, and a maternal mortality rate 97 times higher than the state average.

Among the most famous UC advocates is Janet Fraser who, ironically, lost her baby after five days of home labour; in spite of that she continues to advocate for freebirth. In fact, UC is not endorsed by any scientific organization, as it is considered too dangerous. According to André Lalonde, executive vice-president of the Society of Obstetricians and Gynaecologists of Canada (SOGC):“Freebirth is the equivalent of playing Russian roulette with your child”.

9) “I have the right to deliver wherever I want”

A home birth oxymoron: right to privacy vs. social media exposure

This is a very complex issue with ethical and legal connotations, which has originated intense debate among experts. Even scientific organizations differ in their recommendations. For example, The American College of Obstetricians and Gynecologists, until recently opposed to home births, has decided to temper its position: “…hospitals and birthing centers are the safest setting for birth, but it respects the right of a woman to make a medically informed decision about delivery.” On the other side, the American College of Nurse-Midwives (ACNM) maintains that “every family has a right to experience child birth in an environment where human dignity, self-determination, and the family’s cultural context are respected” and that “every woman has a right to an informed choice regarding place of birth and access to safe home birth services”. Let’s analyze the ethical and legal aspects of home birth:

Ethical issues

These are some of the ethicals dilemmas related to home birth:

Mother vs child safety. Although hospital birth seems to increase maternal interventions in all studies (apparently without increasing severe risk), the baby’s safety remains a subject of debate; taking though in consideration all the studies, there seems to be increased risk for the baby. Let’s take for example the Birthplace study (which is in somewhere in the middle). This study found that, particularly for first time mothers, the baby’s risk is 3 times higher (of which more that half of the cases are death and brain damage). Is it ethically acceptable for a woman to value her birth experience over her baby’s welfare? Is maternal emotional wellbeing so important to justify risking the baby’s health?

Respect for dignity and privacy. “Dignity” may have a different meaning for each person. Some home births supporters feel that the presence of a doctor and the hospital staff make them feel “degraded”; moreover “for some women the possibility of the loss of privacy is a major issue, because privacy is a valued possession”.

Is it not contradictory that so many women, zealous advocates of home birth and their right to privacy, do not hesitate to publish their home birth photographs and videos -some of them with incredible details- in every social media site, where they are exposed to the eyes of millions of people?

Self-determination. In order to make truly informed decisions about childbirth options, women need to be informed of what they are and have the possibility to discuss them. Is it ethical to offer the option of home birth knowing that there is increased risk for her baby?

In theory, the person informing the pregnant woman should inform her objectively and avoid being paternalistic. The problem is that, informed decision-making implies accurate assessment of risks and benefits, but the safety of home birth remains debatable. Is it possible to inform objectively a pregnant woman about home birth? Or the information will be biased according to the health care provider beliefs or experiences?

Other possible ethical issues:

In the home birth situation, are a woman’s reproductive rights and medical responsibility incompatible with each other?

Where do a woman’s rights end and medical responsibility begins, especially considering that the physician is also responsible for the baby’s welfare?

In case of a baby adverse outcome that could have been prevented in a hospital setting, what will be the psychological consequences for the couple?

What is the psychological burden of a home birth in a family’s older children witnessing a home birth? What if a complication occur in their presence?

In Europe, the European Court of Human Rights (ECtHR) ruled in 2010 that Hungary had violated Article 8 of the European Convention on Human Rights (ECHR) because it had interfered with a woman’s right to choose where to give birth. Ms Ternovszky wanted to give birth at home but argued that she was prevented from doing so because a government decree dissuaded health care professionals from assisting home births. This case was the first decision by an international human rights organization on the right to choose the circumstances of giving birth, and was heralded by home birth advocates across Europe.

However, in a recent case against the Czech Republic, the Human rights judges decided that national authorities of each country has “considerable room for manoeuvre” when regulating home births, a matter for which there is no European consensus and which involves complex issues of health-care policy as well as allocation of State resources.

So, is home birth a smart choice or a risky business?

As an obstetrician who supports natural birth, I hear many times the women’s complaints about the excessive medicalization of childbirth. And I feel that sometimes they are right. However, being a mother myself, I never regretted my choice of a hospital birth for my children. After having helped so many women deliver their babies, I have seen many times complications that were totally unpredictable. Occasionally, these sudden complications are so serious, that we have to run -literally- from the delivery room to the operating room to save the baby or the mother! Therefore, even when having skilled professionals attending your home birth, even in countries with very organized structures, the distance to a hospital can prove fatal. Is for this reason that, in my opinion, a hospital birth is without any doubt the best choice for every woman. A birthing center attached to a hospital may also be a good choice.

True, the studies results are controversial, but for me “almost as safe as a hospital birth” is not enough to make me change my mind.

True also, a hospital birth is related to more epidurals, cesarean sections, instrumental deliveries and episiotomies. Regarding the epidural, if you can do it without one, that’s great! But sometimes labor pain is unbearable, and it’s not uncommon to see women without any pain relief who, when the moment to push comes, they are so exhausted and their pain is so overwhelming that they literally lose it. On the contrary, women with an epidural can be more focused and relaxed. The bottom line is: natural birth is not for everybody. And women don’t have to feel guilty because they chose to have an epidural. It’s better to have nice memories of your birth, and for that the epidural can help!

Whether too many cesareans sections are being done is a topic more controversial than home birth itself, and it would deserve a separate article. But what I can say is that, when cesarean sections are done in a judicious way by a conscious physician, they can save your life and your baby’s life. Since hospital births result in better neonatal outcome, it is clear to me that mostinterventions are an inevitable trade-off to save more babies or to avoid severe damage. The same goes for the controversial fetal monitoring, which may lead to more cesarean sections, it may not decrease perinatal mortality, but it reduces by 50% the risk of brain damage. Personally, I would do anything in my power to reduce the chances of having a brain damaged baby.

Of course, a lot that should be done -and can be done- to improve hospital birth: create home-like conditions to help women be relaxed and empowered, allow women to walk during labor, give them possibility to push and deliver in any position they wish, avoid unnecessary interventions such as systematic episiotomies, etc. I believe that some efforts are slowly being done worldwide, but we still have a long way to go!

In conclusion, a woman has the right to choose where to deliver; however, until the risks are clarified, maternal wellbeing may undermine the child’s welfare. Therefore, in my opinion, a natural hospital birth is the safest choice. Natural hospital birth IS possible!You just need motivation and a supportive team…

Hospitals should increase their efforts to provide women with a friendly environment so they can deliver their babies in comfort and total safety. Every baby is precious, every mother is precious!

In the first part of this article we analyzed three important issues related to home birth: personal satisfaction, the mother’s safety and the baby’s risks. Check out the next three reasons women choose a home birth…

4) “I plan to have a home birth, but if something should happen I will go to a hospital”

Even when properly prepared for a home birth, transfer to a hospital is commonly required

As previously mentioned, hospital transportation is a common event: about 1 out of 2 first time mothers and 2 out of 10 second or subsequent time mothers need to be transferred to a hospital; moreover, hospital transfer is almost always perceived by the couple as a negative and disruptive experience (see part 1).

The need for transportation to a hospital can occur before, during of after birth, and can be related to the mother, the baby or both. The top reasons may vary in different countries, although prolonged labour is the first cause of transfer in almost every study, followed by pain relief or the midwife’s unavailability at the onset of labor.

Maternal and fetal necessity for transport is often impossible to predict.

For unpredictable, extremely sudden complications, even rapid transport may not prevent the baby or the woman from death or severe harm, such as shoulder dystocia, sudden cardiopulmonary arrest, or maternal exsaguination (bleeding to death, read Caroline Lovell story here).

Women with severe hemorrhage may already be in shock when arriving at a hospital. Even though the adequate treatment can be immediately instituted, death may nevertheless occur.

Perinatal mortality is higher when transport to the hospital is required.

5) “At home I can have a water birth”

The latest years there has been an increasing demand for water birth

Immersion in water during labor and delivery, although available for several decades, has seen a greatly renewed interest the latest years. In fact, even certain hospitals and birth centers have incorporated birth pools to their facilities. The results of studies analyzing maternal and fetal benefits and risks of water birth are inconsistent, and many times contradictory. The American College of Obstetricians and Gynecologists (ACOG) has just reviewed the subject and a few days ago (November 2016) published an updated statement. What are then the proposed pros and cons of water birth?

For the baby. Supporters of water birth believe that the transition to the outside world is less traumatic for babies born in water as the warm water of the pool may feel like the amniotic fluid; thus water-born babies are supposedly calmer than babies born in air. In fact, no benefits for the newborn were found withmaternal immersion during labor or delivery, neither in 2 systematic reviews including 12 studies and 29 studies respectively, neither in the 2009 Cochrane systematic review, or any individual trials included in ACOG’s review.

The risks

For the mother. ACOG’s review did not find increased risk for maternal infections or postpartum hemorrhage. However, this conclusion must be tempered by the lack of data on rare serious outcomes, such as severe morbidity and mortality.

For the baby. Most studies found that immersion during labor does not increase fetal or neonatal risk. However, concerns have been expressed that immersion during delivery may predispose the infant to potentially serious neonatal complications. Several studies have reported several serious adverse outcomes among neonates delivered in water, these include :

Infection: cases of severe infections with certain bacteria, mainly Pseudomonas aeruginosa (here, here) and Legionella pneumophila (here, here, here, here) have been observed, some of which were fatal. The bacteria causing infections my come from the woman’s body, the water or the pool itself. Recently, a fatal infection by a virus (adenovirus) was reported in a baby born from a mother with gastroenteritis giving birth in a pool.

Water aspiration (drowning or near-drowning): it has been claimed that babies delivered into the water do not breathe or swallow water because of the protective “diving reflex”; however, it has been demonstrated that in compromised newborns the diving reflex is overridden, leading to gasping and aspiration of water. Actually, it seems that even healthy babies may be at risk of water aspiration, which may result in hyponatremia and seizures.

Umbilical cord avulsion(cord “snapping” or cord rupture): this complication may happen in 1 out of 288 water births and occurs when the baby is lifted out of the water; in some instances the affected newborns have required intensive care unit admission and transfusion.

Unpleasant environment: women may feel uncomfortable about accidentally defecating in the pool; which, as stated above, may also predispose the baby to severe infections.

Disappointment with pain relief: for some women, immersion in water is not enough to relieve pain.

Monitoring and emergencies: it may be difficult to quantify blood loss (see photo); in cases of concern about the baby’s heartbeat, monitoring may be difficult; moreover, in the event of a severe maternal complication (such as fainting or heavy hemorrhage) it may be difficult to move the pregnant woman out of the water.

Several professional organizations, including the Royal College of Obstetricians and Gynaecologists and the American College of Nurse–Midwives, support healthy women with uncomplicated pregnancies laboring and giving birth in water. According to ACOG, immersion in water during the first stage of labor may have benefits for the mother and may be offered to healthy women with uncomplicated pregnancies; however, there are insufficient data regarding the relative benefits and risks of immersion in water during the second stage of labor and delivery. Therefore, until such data are available, “it is the recommendation of the American College of Obstetricians and Gynecologists that birth occur on land, not in water”. The British National Institute for Health and Care Excellence (NICE) recommendations are in agreement with the ACOG.

6) “In the Netherlands women have been delivering at home for more than fifty years”

The Netherlands has the highest percentage of home births in the Western world

The Netherlands is a country with a long tradition of home birth, with well-trained midwifes, organized transport system and short distances to hospitals. However, it is one of the few countries in the world where the incidence of home births is decreasing: in 1965, two-thirds of Dutch births took place at home, but that figure has dropped to about 20% in 2013. Moreover, Dutch women have to pay an extra amount (around €250) when deciding for a “nonindicated hospital birth” under the guidance of an obstetrician or a midwife (here). According to Professor Simone Buitendijk, head of the child health programme at the Netherlands Organisation for Applied Scientific Research, “… home birth rates have dropped like a stone. Soon, there will not be enough demand to justify the infrastructure” she says. “Then the system will collapse – and let there be no misunderstanding: we won’t be able to rebuild it”.

This drop in home births seems to be related to the increasing awareness of the media, patients, and obstetricians about the risks of home birth (here). Even more skepticism originated the results of the Euro-Peristat study: the Netherlands is one of the countries with the worst perinatal outcomes of Western Europe.

Sexual intercourse is supposed to provide pleasure, satisfaction and fulfilment. We -particularly women- tend to expect flawless, movie-like sex, romantic, luscious or passionate, with music playing in the background! Well, in real life sex is not always that perfect: according to an American survey, about 1 out of 3 women reported pain the last time that they have had sex. What’s more, many women feel ashamed to talk about it, giving up the idea of pleasurable sex. It is not unusual for these women to avoid having intercourse, leading to couple conflicts and eventually to psychological problems…

But why so many women feel pain while making love?

Whether it happens each time or occasionally, you feel just some discomfort or unbearable pain, dyspareunia (painful intercourse) can be related to a gynecological or medical problem, to your emotions or your state of mind; occasionally your partner is to blame, or maybe both of you, let’s not forget that it takes two to tango!

Below you will find 8 common painful situations you may encounter during intercourse. Understanding the type and location of the pain will help us pinpoint its cause, so that you can take some measures to get over it!

Problem # 1: “I feel a burning sensation outside the vagina”

You may feel a painful, burning sensation in your vulva (the external genitals), the area may be red and eventually swollen.

Possible causes:

Yeasts or other infections: a yeast infection will cause “cottage cheese-like” discharge; other bacteria can produce yellow or green discharge which may also be foul-smelling.

Contact dermatitis: you may realize that the problem starts after using certain lubricant, soap or cream, laundry soaps or softener; certain clothes can also be responsible.

Allergic reactionto condoms: the burning feeling starts after having sex, usually within 48 hours.

Check with your doctor, who can give you a treatment for your yeast infection, if you are prone to get them, over-the-counter medications are available.

In the doubt, your doctor may order a culture, to see which bacteria is responsible for your symptoms.

In case of dermatitis or allergic reaction, stay away from possible irritants, your doctor can prescribe you a cream to soothe discomfort.

If you are allergic to latex (the material condoms are made of), stick to non-latex condoms.

Problem # 2: “I have a painful bump in my vulva”

You may feel a sharp, localized pain; while trying to precise its location you may touch a “bump” in the vulva. If you look with a mirror you may be able to identify the spot. Sex, due to rubbing, will make it even more painful.

Possible causes:

Pimple or ingrown hair: these are the commonest “bumps” appearing in the genitals. They can be quite sore if they become infected. A clogged sweat gland can also cause a painful pimple.

Bartholin gland cyst: they are soft cysts arising at the opening of the vagina. They can be very large (like a walnut) and become extremely painful if they get infected.

Herpes: genital herpes is a sexually transmitted infection. It causes itchy, burning and painful lesions that often start as a sore spot, becoming over a few days one or several blisters. Read more here.

Other dermatological or medical problems: rarely, diseases causing genital ulcers may be the cause of pain.

What to do about it:

Check with your doctor if you are not sure what is causing you pain.

Pimples may require a local cream to relief pain. If they are infected antibiotics may be necessary; more rarely incision and drainage are needed.

Bartholin cysts are treated with warm sitz baths. If infected antibiotics, incision and drainage may be necessary.

Herpes is managed with antiviral medications (locally or by mouth), painkillers may also be required.

If penetration was never possible, check with your doctor who can rule out any anatomical problem; most of them can be solved with a simple surgical intervention.

Problem # 4: “I have intense pain in the opening of the vagina during penetration”

Even if you are aroused and willing to have sex, penetration triggers an intense pain in the entrance of the vagina; this is called entry dyspareunia.

Possible causes:

First time: we tend to have high expectations about our first intercourse; however many times it is less extraordinary than expected, and this includes pain; sometimes (but not always) bleeding may occur.

Trauma: this can be the result of childbirth (a tear or an episiotomy) or surgery; occasionally injury can be sex-related.

Vaginitis: due to yeast or other infection (see above).

Vulvodynia: it is a distressing, long-lasting condition in which the vulva is so sensitive that just touching the area makes the woman jump with pain. When pain is confined to the vestibule (the area around the opening of the vagina), it is known as vulvar vestibulitis syndrome (VVS). Its cause is unknown.

Emotional reasons: see below.

What to do about it:

If it is your first time, don’t worry too much about it. Many women have pain or discomfort during their first intercourse, an even a larger percentage will not have an orgasm. Be patient, try to be as relaxed as possible, discuss with your partner the means to reduce pain. If the problem persists, discuss it with a doctor.

If your just delivered, wait to have intercourse for at least six weeks after childbirth; some discomfort may persist for a few months, especially if you breastfeed, since your vagina also feels dry (see below). If pain continues for a long time or is very intense, talk to your doctor.

Vulvodynia may require medications, or eventually surgery. Read more here.

Problem # 5: “My vagina feels too dry”

Vaginal dryness is extremely common, and does not always mean problem. While some women produce a lot of vaginal secretions, others are drier. However, there are factors that influence natural lubrication levels: sexual stimulation increases the amount of secretions; therefore, adequate and prolonged foreplay will help you being aroused. Sometimes though, your vagina keeps being dry and sex becomes painful.

Possible causes:

Menopause: due to the low level of estrogen (the hormone in charge of lubricating your genitals), your vagina will feel extremely dry and sex can be very painful, sometimes impossible.

Breastfeeding: also related to low estrogen.

Medications: some medications such as birth control pills, decongestants and antihistaminics may reduce vaginal moisture; contraceptive pills can also decrease sexual desire.

Use a lubricant. Water-soluble lubricants are the best choice if you experience vaginal irritation. Silicone- based lubricants last longer and are more slippery. Do not use petroleum jelly, baby oil, or body lotion with condoms, as they can cause the condom to break (read more here).

For chronic cases, you may try long-acting vaginal moisturizers which, unlike lubricants, are absorbed into the vaginal lining for 3 to 4 days, mimicking natural secretions.

For menopausal women, when lubricants or moisturizers won’t work, a vaginal estrogenproduct may be necessary. More info here.

In any case, talk to your doctor if lubricants or moisturizers don’t help.

Problem # 6: “My vagina is just not opening”

Each time you try to have sexual intercourse, your vagina “closes”; any attempt of penetration is painful, and usually impossible.

Possible causes:

Vaginismus: it is a tightening (or reflex contraction) of the muscles of your vagina which occurs during penetration, but eventually also while attempting to insert a tampon, or during a gynecological exam. Its cause is unknown, although it is frequently related to anxiety, or fear of having pain during sex. Learn more here.

Interstitial cystitis (IC): also called bladder pain syndrome (BPS) is a chronic problem, which causes a feeling of pain and pressure in the bladder area, together with burning during urination. IC may feel like a bladder infection, but it’s not an infection; in fact, its cause is unknown.

What to do about it:

Read here to see what you can do if you have a bladder infection, particularly if you get one very often.

Regarding BPS, check with your doctor. No single treatment works for every woman, it should rather be individualized and based on symptoms. Learn more here.

Problem # 8: “I feel a deep pain in my abdomen during sex”

A deep pain or cramping in your abdomen during sex -or deep dyspareunia – can be the result of numerous problems.

“Collision dyspareunia”: a funny name to describe the pain you may feel if the tip of your partner’s penis hits your cervix. This can happen if your partner is longer than average, if you’re not fully aroused, or if your cervix is unusually positioned. Read more here.

Other reasons: constipation, a retroverted uterus, a forgotten object in the vagina (usually a tampon).

What to do about it:

Although many of the causes of deep dyspareunia are not important, some of them can be serious; therefore, you should see a doctor, especially if it is a new-onset problem. Many of these situations will be treated with medications, others require surgical intervention.

THE EMOTIONAL FACTOR

The way you feel about having sex: fear, embarrassment, guilt, being concerned about your physical appearance, being to too anxious about “doing it right” can all may make you unable to relax; therefore, arousal is difficult and you end up having pain.

Stress, fatigue, anxiety, depression: your everyday life problems can affect your desire to have sex. In addition, your vaginal muscles tend to tighten; this can also contribute to painful sex.

Relationship problems: problems with your partner may be related to painful sex by reducing arousal or provoking vaginismus.

A previous bad sexual experience: such as women with a history of sexual abuse, who tend to relate sex with something bad or negative.

WHEN YOUR PARTNER IS THE PROBLEM…

Painful sex is not always your fault!

Your partner may have sexual problem, which in turn can make you feel anxious about sex.

If your partner is taking a drug for erectile dysfunction, he may have delayed orgasm, causing long and painful intercourse.

Size problem: feel that your partner is “too big”? In fact, when a woman is aroused and relaxed, the vagina extends by several inches – so most women should be able to accommodate most males! Nevertheless, if size is indeed a problem, try a lubricant, and check which sex positions are less likely to make you hurt. Come close, a new device can be a good option for you.

SHARED PROBLEM: SEXUAL MISMATCH

Besides size mismatch, or differences in the way you both enjoy sex, a common issue leading to painful sex is mismatched sexual desire. Read more here.

TAKE HOME MESSAGE

If you have pain during sex, talk about it! It may be embarrassing to discuss your sexual problems with a doctor, but you should know that, with proper care most problems can be solved; therefore there is no reason to condemn yourself to a pleasureless, painful sexual life!

In the meantime, these are some tips that may help you relieve your pain:

Talk to your partner: mutual communication is essential. Discuss with your partner where and how is the pain, so you can both find ways to avoid it or minimize it.

Use a lubricant: a simple measure that can ease your suffering. It’s a good idea to keep always one with you.

Make time for sex: not always easy to include sex into our busy schedules! Nevertheless, try to find a moment of the day when you and your partner will be less tired or anxious.

Engage in sexual activities that don’t cause pain: if penetration is painful, you may consider other forms of pleasure, such as oral sex.

Try different sex positions: if you have deep dyspareunia, it can be worse in certain positions. Try to find those that are less likely to trigger pain.

Include relaxing activities: your partner may give a massage.

Take steps to relieve pain before making love: take a warm bath, empty your bladder, take a painkiller.

If you experience burning after intercourse: apply a frozen gel pack or some ice wrapped in a towel to your vulva.

Pregnancy usually comes with a lot of joy… but sometimes it can be pretty overwhelming! Especially the first trimester, when your body starts changing. These changes are not the same for all women, though: while some women feel great and full of energy, others feel completely miserable…

Food cravings, nausea, mood swings… You have most likely heard about these pregnancy symptoms, but… what is normal? What to do about them? When to call your doctor?

In this article you will find a list of 16 common symptoms you may experience during the first trimester of pregnancy (weeks 0 to 13), you will learn why they happen, what you can do about them, and when to call your doctor -or midwife.

1) Abdominal cramping and backache

Why it happens: one of the earliest pregnancy symptoms, this slight cramping confuses many women who believe they’re about to have their period. Abdominal and back pain are caused by normal, mild uterine contractions related to the increasing pregnancy hormones.

What can you do about it: nothing, unless pain gets intense or comes with vaginal bleeding.

When to call your doctor: if you experience strong pain, or if you have pain and bleeding, in order to rule out certain pregnancy complications (see vaginal bleeding) or other conditions unrelated to pregnancy.

2) Acne

Why it happens: this is a very common symptom -pimples appear in about 50% of women- and sometimes can be quite intense. The β-HCG hormone (beta – human chorionic gonadotrophin), which raises from the beginning of pregnancy has androgenic effect (mimics male hormones), leading to increased skin oil production and the appearance of acne.

What can you do about it: most of medications used to treat acne are not allowed throughout pregnancy -isotretinoin, one of the most effective acne medications is also one of the most dangerous during pregnancy. Be patient! pregnancy acne will resolve after childbirth.

In the meantime, just get some good medication-free skin care:

wash your face and body with a gentle cleanser, alcohol and oil-free,

avoid over-cleansing as it may have the opposite effect,

shampoo regularly and avoid oily hair mousse,

do not pop your pimples, since it may cause permanent scarring.

When to call your doctor: If your acne is severe, you may consult a dermatologist to get the most adequate care for your skin type.

3) Bloating and constipation

Why it happens: during pregnancy a hormone called progesterone relaxes the bowels wall and slows down their activity in order to allow the absorption of more nutrients to feed your growing baby. The downside: you may feel bloated, gassy and get frequently constipated.

What can you do about it:

increase your fiber intake,

avoid foods that cause bloating (beans, cauliflower, etc),

drink plenty of fluids,

engage in physical activity.

When to call your doctor: if constipation really bothers you, ask your doctor for a laxative or stool softener that is safe for pregnancy.

4) Breastswelling and tenderness

Why it happens: your breasts, under the influence of the high hormones, start getting ready for breastfeeding, thus they engorge and receive more blood supply; this will cause tenderness and swelling.

What can you do about it:

wear a support bra (you may need to get a bigger size),

avoid lacy or wired bras.

When to call your doctor: if you get severe breast pain or redness, or if you palpate any lump.

5) Dizziness and fainting

Why it happens: your blood vessels dilate to increase blood supply to the womb and to your baby, leading to a drop in blood pressure, which can make you feel dizzy, lightheaded, or even faint. Dizziness can also be due to low blood sugar, especially if you are not eating adequately.

What can you do about it:

avoid prolonged standing,

rise slowly when you get up from sitting or lying down,

be especially careful if you drive or execute activities that require special concentration,

eat healthy, frequent meals (every two to three hours),

drink plenty of fluids to raise your blood pressure.

When to call your doctor: if your experience intense dizziness, especially if you have bleeding or intense abdominal pain, to rule out a miscarriage or an ectopic pregnancy (see vaginal bleeding).

6) Fatigue and sleepiness

Why it happens: from early pregnancy,your body has some extra work to do! Your metabolism increases and you start preparing the placenta; these changes together with the high progesterone levels are responsible for this constant feeling of drowsiness and intense fatigue. Your body reminds you that you should get some rest, so you will be stronger to carry your baby!

What can you do about it:

take naps and rest when possible,

eat healthy,

drink plenty of fluids,

avoid standing up for long periods of time.

When to call your doctor: if you feel that your drowsiness affects your daily activities, inform your doctor who can rule out other possible causes of fatigue such as anemia. If you have intense sleepiness together with negative feelings, hopelessness or sadness, inform your doctor to rule out depression.

7) Food cravings, food aversions

Why it happens: the sudden hormonal increase changes your food tastes; therefore, you may get food cravings -a sudden and intense urge to eat something in particular, which may eventually be quite unusual- or food aversion -repulsion for certain foods, even with the thought of them.

It is believed that during pregnancy our body asks for what it needs -hence cravings- and makes us reject things we don’t need or may be harmful, such as aversion to cigarette in smokers (unfortunately, this is not always the case).

What can you do about it:

Cravings:

Go ahead and indulge yourself with what you crave, provided that you generally follow a balanced and healthy diet,

when you crave for unhealthy foods, try to avoid excess: eat one scoop of ice cream, not the whole 1-kilo carton!

if cravings are too frequent, try to do activities to distract yourself so that you don’t think about food all the time: go for a walk, talk to a friend, read a book, go to the movies…

Aversions:

Most food aversions will go away after the first trimester, so most likely you will be able to eat meat or drink milk again thereafter,

if you keep having aversion to certain foods, try to find healthy substitutes for what you can’t tolerate, e.g., have calcium-fortified cereals if you can’t drink milk.

When to call your doctor: If you crave for clay, ashes or dirt -a condition called pica– as this can be really dangerous for you and your baby; if your food aversions are too intense and followed by frequent vomiting (see Nausea and vomiting).

8) Frequent urination

Why it happens: you may notice from very early in pregnancy that you need to pee more often. As your body blood flow increases with pregnancy, more blood goes to the kidneys in order to flush more waste products out of your body; this leads to increased urine production. Urination is more frequent during the night because the fluid you had retained in your legs during the day will get reabsorbed when you lie down. In addition, as the uterus grows it starts putting pressure on the bladder.

What can you do about it:

don’t hold you urine, as this can predispose you to urinary infections,

avoid too much caffeine (coffee, tea, cola drinks) since they have diuretic effect,

don’t drink too much before going to bed.

When to call your doctor: If, besides frequent urination, you feel burning or pain when you pee, or you see blood when wiping: these can be signs of a urinary tract infection.

9) Headaches

Why it happens: headaches occur frequently early in pregnancy mostly due to the increased hormone levels; but low blood pressure, low sugar, anemia or dehydration can all worsen headaches. Women who had migraines before getting pregnant may experience worsening in the first trimester, but usually improvement as the pregnancy progresses.

What can you do about it:

drink plenty of fluids,

eat frequent meals,

get some rest when possible.

When to call your doctor: If headaches persist, check with your doctor whether you can take acetaminophen (Tylenol), which is usually allowed throughout pregnancy. Contact you doctor if your headaches are too intense, do not subside with Tylenol or are accompanied by visual disturbances or other symptoms.

10) Heartburn, heavy stomach

Why it happens: Again, progesterone is responsible for relaxing the sphincter (ring of muscle) that separates the stomach from the esophagus; this leads to acid reflux.

What can you do about it:

eat small, frequent meals, don’t eat too much before going to bed,

avoid too spicy, greasy, acidic or sweet foods,

don’t lie flat, sleep with two or more pillows to have your head at a higher level than your body.

When to call your doctor: if you can’t cope with heartburn, ask your doctor to prescribe you an antiacid medication that is safe for pregnancy.

11) Mood swings

Why it happens: mostly because of your hormones, but eventually increased by your dizziness, nausea or other pregnancy symptoms, you may feel at times irritated or depressed, anxious or out of energy, overjoyed or panicked! Is not only hormones, though. Pregnancy will bring major changes to your life, so it’s natural to worry about many things: whether your will make it through labor and delivery, if you baby will be fine, whether you will be a good mother, if the relationship with your partner will be affected, etc, etc… Most women will also become more forgetful; while this is normal, it may be quite frustrating…

What can you do about it:

talk about it, find someone who can listen to you: your partner, a family member, a friend, or other mums-to-be,

ask for understanding and support, not only psychological but also physical: if you can’t do certain activities at work or a home, let someone help you,

get some rest: you may feel worse if you are tired or sleep-deprived,

engage in activities that calm you down and relax you; mild exercise can also help.

When to call your doctor: if you feel constantly down or overwhelmed, if you have negative or suicidal thoughts, if you can’t go ahead with your daily life; in these situations you may need professional help.

12) Nausea and vomits

Why it happens: nausea is one of the commonest pregnancy symptoms (occurs in about 85% of pregnancies). It is not fully understood why it happens, but it seems to be related to β-HCG levels: the higher levels, the more nauseous you may feel (e.g., women carrying twins).

Nausea and vomits usually start around the 6th week of pregnancy and persist until week 13, although they may last up to the 16th – 20th week, or more rarely beyond 20 weeks. They can be of variable intensity, for some women very mild, for others very severe, leading to continuous vomiting. Nausea may be more intense during the morning -that’s why it’s called morning sickness– although this is not always the case.

What can you do about it:

nausea gets worse when you have empty stomach, therefore, have frequent and small meals,

foods with high starch content may relieve nausea (crackers, potatoes, rice, pasta), but each woman find which foods can tolerate and which not,

avoid food with strong smell or taste,

ginger can help (either raw ginger, ginger ale or ginger pills),

accupressure, motion sickness wristbands and vitamin B6 can also be effective,

stress and tiredness can worsen nausea, therefore try to get plenty of rest,

keep drinking to avoid dehydration, but drink small amounts of fluids at a time, since large amounts can make nausea worse.

When to call your doctor: if nausea doesn’t allow you to eat or drink anything, or if you can’t stop vomiting, your doctor can prescribe you certain medications that may be helpful. Sometimes intense vomiting may lead to dehydration, a condition called hyperemesis gravidarum, which requires admission to a hospital for rehydration and intravenous treatment.

13) Nosebleed, stuffy nose, gum bleeding

Why it happens: blood flow increases in pregnancy, and your gums and nasal lining are very fragile and bleed easily. Gums may bleed when you brush your teeth. Nosebleeds may appear when you blow your nose; you may also notice that your nose gets more easily congested, also as a result of the increased blow flow to the nose’s mucous membranes.

What can you do about it:

keep seeing regularly your dentist to rule out certain gums problems, which are common in pregnancy and may increase bleeding,

switch to a softer toothbrush,

to stop nose bleeding pinching your nose for a few minutes should help,

for your nose congestion you may use a humidifier, or try a saline nasal spray,

don’t use nose spays or other decongestants without checking with your doctor.

When to call your doctor: if your gum or nose bleeding are heavy or too frequent. If your nose congestion gets too intense and you can’t breathe.

14) Smell intolerance, increased sense of smell

Why it happens: many women won’t stand certain strong smells, either from food, cosmetics or others sources, triggering nausea or vomits. This sensitivity to smells is hormone-related; it is said that nature prepares you to “sense” dangerous threats in order to protect your baby.

What can you do about it:

avoid foods with intense smell,

you may need to stop cooking for a while -if possible,

don’t use scented cosmetics if the smell bothers you; this is also true for laundry soap, softeners, air fresheners, etc.

When to call your doctor: in case your smell intolerance leads you to intense vomiting (see Nausea and vomits).

15) Vaginal bleeding

Why it happens: Bleeding during the first trimester is extremely common (it happens in about 25% of pregnancies) and is usually of no concern. A slight bleeding may be due to the implantation of the embryo in the uterus; sometimes a small detachment of the sac from the uterine cavity -or subchorionic bleeding- may be the reason; an inflammation of the cervix may occasionally cause slight bleeding (mainly with intercourse). Sometimes though, bleeding can be worrisome, i.e., when related to threatened miscarriage or ectopic pregnancy (a pregnancy outside the uterus).

What can you do about it:

keep track of the amount and characteristics of the blood,

don’t have intercourse, don’t use tampons,

according to the cause of the bleeding, you may be asked to get some bedrest, and refrain from heavy work or heavy lifting.

When to call your doctor: If you see blood, you should inform your doctor, even if you have light bleeding, as it may not be always easy to understand when bleeding is to worry about. But you should call your doctor right away (or go to the emergency room) if you have heavy bleeding, cramps (like intense period pain), or sharp pain in your abdomen, as these can be signs of miscarriage or ectopic pregnancy.

16) Vaginal discharge

Why it happens: Your high hormones are responsible for an increase in vaginal discharge, that should be white or clear, and thin.